Passport Details
Do you have a passport? If so, fill in the information below. If not, get it as soon as the trip is approved by the School Board.*
No Yes
Country of Passport
Passport Number
Passport Expiration Date
Day Month Year
Parent/Guardian Details
Parent/Guardian Name*
Prefix First Name Last Name
Relationship*
Phone*
Cell Phone
Email
Parent / Guardian Name
Prefix First Name Last Name
Relationship
Phone
Cell Phone
Email

References
Please list your references and upload a letter of recommendation below in the Supporting Documents section.
Spanish Teacher*
High School You Attend*
Reference 1
Relationship to you
Letter of recommendation from Reference 1
Reference 2
Relationship to you
Letter of recommendation from Reference 2

School Record
Please provide proof of your two years of Spanish study (transcript) or novice high proficiency level (evaluation results), your attendance record, and a statement from your school to show no discipline referrals, detentions, or suspensions.
Copy of your official transcript or proof of novice high proficiency level in Spanish.
School attendance record
Proof of No Discipline Problems at School
Comments
Declaration
By student applicant.*
I hereby declare that I have provided accurate information in this form about myself.
Student Applicant Signature*
Clear
Parental Permission*
I, the parent/guardian of the applicant hereby consent to this application.
Parent/Guardian Signature*
Clear
Should be Empty:

Costa Rica Homestay Preliminary Information Form

Parent/Guardian Contact Details